Why, I wonder, aren’t we outraged that it’s taken this long? Why do we respond with little more than a collective shrug to the admission that doctors and hospitals have for decades made a practice of withholding such important information from patients and dishonestly denying fault when sued?
A recent article in the New York Times explored this issue. The article acknowledges what medical researchers have long known:
* There is far more medical negligence than anyone cares to acknowledge. Most studies estimate that 1 in every 100 patients receives negligent care
* 98,000 people die every year as a result of medical carelessness, more than twice as many as are killed in car crashes every year
* As few as 30% of negligently injured patients are ever told that their harm was caused by a mistake
* Only a small fraction of injured patients, perhaps only 2%, ever pursue a lawsuit.
* Insurance companies and malpractice lawyers have advised doctors and hospitals to “deny and defend,” even when the claims have merit
* Many lawsuits are filed primarily because angry patients can’t get honest answers any other way
While disclosure has been regarded as an ideal by medical ethicists for years, in practice doctors and hospitals have actively frustrated efforts by injured patients to learn the truth about how their injuries occurred. Questions go unanswered; relevant information is omitted from records; outright false information is provided to patients and families; and doctors, nurses and hospital staff link arms in a unified “white wall” designed to keep patients and families from learning the truth about the mistakes that killed or maimed their loved ones. Most people don’t know this but it’s true in most states that hospitals that discover that a doctor negligently killed an innocent patient may keep the information they discover secret, may conceal the truth from the family, pursuant to “Peer Review” laws.
A handful of prominent medical centers are trying a new approach. University hospitals at Stanford, Harvard, the University of Michigan and Johns Hopkins are promptly disclosing errors, offering earnest apologies and making compensation to injured patients. As Richard Boothman, chief risk officer at the University of Michigan put it, “Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial.”
Somewhat surprisingly, these hospitals are also finding that the rate of malpractice lawsuits has dropped dramatically since honesty became their policy. The University of Michigan, for example, has seen a drop in malpractice claims from 262 in August 2001 to 83 in August 2007. So, not only is honesty the right thing to do, but it’s good for doctors, too!
Still, there is plenty of resistance to honesty in the medical profession. Some say they won’t consider telling the truth if it means acknowledging fault unless states pass laws that protect them from having the truth used against them. How about that? Who among us thinks that if we carelessly kill or maim someone we should be able to keep the truth to ourselves? The police officer who carelessly runs a red light and kills a pedestrian in an intersection has to tell the truth. The train engineer who forgets to reduce speed approaching a heavy traffic area and kills people at a grade crossing has to tell the truth. The architect who miscalculates the load bearing capacity of a balcony and causes death or injury when it collapses has to tell the truth. And lawyers? Not only do we have to tell the truth, we have an affirmative obligation to reveal our mistakes, even when none would ever be the wiser.
I will confess that it offends me that doctors would even consider asking, and legislators would consider enacting, laws that protect a class of citizens from the truth being used against them. Already doctors are more protected than anyone else in society, save perhaps prosecutors. Now they tell us they won’t even admit the truth when they kill someone unless we, as a society, promise that we won’t hold it against them?
I say, “Man up.” Or “Woman up,” if you prefer. How about this for a novel approach? Be honest. Be forthcoming. Act like a professional. If you make a mistake and you hurt someone, own it. Make it right. Everyone else does, or should. So should all of you in the medical professions.